Medicare e-prescribing: How to receive your 2% bonus

The Centers for Medicare & Medicaid Services in November released a guide for physicians who plan to pursue Medicare e-prescribing incentives that start in 2009. Here's what CMS says doctors should do.

Step 1: Obtain an eligible system

Physicians must have or acquire a qualified electronic prescribing system that can:

• Generate a complete medication list with available data from pharmacies and benefit managers.
• Select medications and transmit prescriptions electronically (not via fax) following applicable federal standards, after warning the prescriber of any possible safety issues associated with the drug orders.
• Provide information on lower-cost, therapeutically appropriate alternatives.
• Provide drug plan information, such as formularies, patient eligibility and authorization requirements.

Step 2: Report the appropriate measures

Starting with applicable services rendered on or after Jan. 1, 2009, physicians must report the appropriate combination of CPT codes and special G-codes on Medicare claims. For example, a doctor might bill code 99213 for a mid-level patient checkup and also report code G8443 if the visit resulted in an electronic drug order.

Code G8445 applies for visits during which no prescriptions were ordered. G8446 applies when the drug orders could not be made electronically because of pharmacy limitations, federal or state restrictions, or patient preference.

Step 3: Qualify for a bonus

Physicians must submit all claims including e-prescribing codes no later than two months after the end of 2009.

To be eligible for the bonus, the services a doctor provided that can be linked to an e-prescribing measure must make up at least 10% of his or her Medicare charges for the year. In addition, the physician must report the appropriate G-codes for at least 50% of the cases in which they apply.

If CMS determines a physician qualified, he or she will receive a 2% bonus on all 2009 Medicare pay. Bonuses will be paid in 2010.

For more information

"Medicare's Practical Guide to the E-prescribing Incentive Program" is available online in pdf (link).

A separate "Clinician's Guide to Electronic Prescribing," produced in collaboration between CMS, the American Medical Association and other organizations, also is available online (link).